Foreign Aid, Development, and Public Health in Africa

Lia Tadesse Gebremedhin is currently the Executive Director of the Harvard Ministerial Leadership Program and a Professor of the Practice of Public Health at the Harvard T.H. Chan School of Public Health.

Lia served as the Minister of Health of Ethiopia from March 2020 to February 2024 after serving as State Minister of Health from November 2018. As a Minister, she spearheaded the COVID pandemic response and helped her country navigate the pandemic with resilience. Before that, she served as Program Director at the University of Michigan’s Center for International Reproductive Health Training (CIRHT). She was also the Project Director of USAID’s Maternal and Child Survival Program (MCSP) at Jhpiego-Ethiopia and CEO and Vice Provost of St. Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa, where she led hospital service and academic reforms.

Lia is passionate about strengthening and reforming health systems and has received several recognitions for her accomplishments in fighting the COVID-19 pandemic, in advocacy for gender equity, access to quality health services and training, and has published over 40 articles, commentaries, and papers. 

During her tenure as minister, Lia was co-chair of the COVAX AMC Engagement Group, co-chair of the Global Financing Facility (GFF) Investors Group, the Vice board chair of the Africa CDC, and a member of the Gavi board and the WHO Executive Board. She currently serves on the board of Directors of JSI and Resolve to Save Lives, as a Commissioner in the Lancet Commission of Investing in Health, and serves on various Advisory boards including the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, the Center for Global Health Equity at the University of Michigan, the Advisory board for the Lancet Commission on Evidence-Based Implementation in Global Health, and the Global Advisory Board for the QuEST Network at Harvard T. Chan School of Public Health.

She earned her medical degree from Jimma University, specialty training in Obstetrics and Gynecology from Addis Ababa University, and a master’s degree in health care administration from Jimma University.

Abstract:

Foreign Aid, Development, and Public Health in Africa

Lia Tadesse Gebremedhin, M.D, MHA

Over the years, Overseas Development Assistance (ODA) has played a key role in enhancing economic and social progress and narrowing the equity gap, contributing to improved education, health, environmental sustainability, good governance, gender equality, and access to global public goods.

When we look particularly at public health, development assistance for health (DAH) to sub-Saharan Africa rose from roughly US$8 billion in 2005 to about US$27 billion in 2022, even after pandemic-related spikes began to level off. However, the paradox between billions of ODA committed to Africa and the lack of visible results to match them remains a contradiction. Despite the increased committed funds, a large portion of ODA never reached the intended destination and has undermined the formation of sustainable universal health coverage financing models. This major concern regarding aid ineffectiveness led to the adoption of the Paris Declaration in 2005.

The Paris declaration advocated for collective commitment towards alignment with country priorities, harmonization, mutual accountability, and managing results to address the fragmentation, lack of predictability, and the predominant financing of “inputs” rather than “outputs”. Despite this, the challenges persisted, signaling that the current architecture of official development assistance is no longer fit for purpose.

In this background, recent cuts by global donors signal a rapidly evolving global development landscape. This acute change is occurring on top of decreasing foreign aid years before the COVID-19 pandemic, and it will have the greatest impact on sectors like health and countries that are most reliant on ODA. The potential consequences of rapid ODA reductions are already becoming apparent with disruptions in the procurement of essential supplies, interruptions to care delivery, and closures of research and development projects. The predicted long-term reversal of gains in morbidity and mortality is also alarming.

Although these shifts in the global development ecosystem pose serious challenges, particularly for Africa, they also bring tremendous opportunities to redesign strategic approaches towards building more resilient health systems for the continent. In this lecture, we will hear about this journey of foreign aid and development in public health in Africa, blended with my own experience as Ethiopia’s Minister of Health and a public health leader.